The Bilingual Therapy Crisis: London’s Arabic-Speaking Therapists on Power, Trauma, and Translation

One type of difficulty that doesn’t make the news is the one that occurs in quiet, small rooms between a client and a therapist who are both struggling to find the right words. This challenge has been developing for years in the Arabic-speaking communities of London, and the practitioners caught in the middle are the ones who comprehend it the best.

What bilingual Arabic-English therapists already know from experience—that language in the therapy room is never neutral—has started to be mapped by research emerging from British clinical settings. It is heavy. It conveys either inclusion or exclusion. It has the ability to both open and close a trauma. According to a study looking at the experiences of bilingual Arabic-English therapists in the UK, practitioners don’t just switch between languages; instead, they switch between completely different versions of themselves, each with its own emotional register, cultural responsibilities, and power.

The difference is more important than it may first appear. For many native speakers, Arabic is more closely associated with emotional memory. Instead of a clinical consultation, it is the language of childhood, family disputes, and grief communicated at the kitchen table. English, on the other hand, frequently functions as a buffer; it is helpful for analysis, distance, and describing pain from a small distance. Sometimes bilingual clients select English specifically because it enables them to discuss a subject without fully experiencing it. It is difficult to expect someone who is already handling the weight of the session to maintain that dynamic consciously when working in two languages as a therapist.

Then there is the institutional aspect, which is more difficult to discuss in a courteous manner. Arabic-speaking patients were not taken into consideration when developing Western psychological frameworks. English-language assessment instruments don’t always translate well, both conceptually and linguistically. Therapists frequently find themselves performing real-time interpretive work that goes far beyond what their training prepared them for, and the emotional vocabulary of standard clinical instruments can land awkwardly when rendered in Arabic dialects. The system seems to be expecting them to adapt, but it doesn’t fully recognize the extent of that expectation.

The fact that many Arabic-speaking therapists working in London are also members of the diaspora further complicates matters. Some have experienced the same wars, displacements, and other geopolitical upheavals that brought their clients to Britain. A layer of secondary trauma is created by the therapist-as-refugee dynamic, as some researchers have begun to refer to it, which supervision may not always sufficiently address. It takes a very particular kind of compartmentalization to sit across from someone who is describing the devastation of a city you also left. The mental health system may believe that this division occurs on its own. It doesn’t.

In an effort to close some of these gaps, organizations like Arabic Therapists UK and the Nafsiyat Intercultural Therapy Centre in London provide clients who might not otherwise receive any meaningful support with culturally sensitive care in Arabic. There is a genuine demand. The supply isn’t keeping up. It’s difficult to ignore the fact that the communities with the least access to appropriate care are also the ones most likely to experience intergenerational and geopolitical trauma.
It’s hard to measure what is lost when that care isn’t available, but it’s easy to imagine. Certain types of pain can only be described in the language in which they were initially experienced. In addition to being inconvenient, a system that is unable to take that fact into account is inadequate.